An European overview of genetic counselling supervision provision

Counseling supervision for genetic counselors: A proposed outsider witness structure

Counseling supervision for genetic counselors is recognized as an important aspect of professional registration. Professional bodies in countries, including the United States, Australia, and the United Kingdom, have published recommendations for the delivery of counseling supervision covering such things as access and frequency of delivery. Yet, there has been little written about the theoretical frameworks underpinning counseling supervision or how these have been applied within this setting. We present a structure for group counseling supervision for genetic counselors (GCs), informed by narrative therapy, and suggest how it can be adapted for online delivery. The format of the group session is detailed to allow for the outsider witness approach to supervision to be replicated in other genetic centers. We wish to encourage more research in this area to explore models of supervision, including involvement of counseling supervisors trained in strength-based approaches such as narrative and compassion-focused therapy. These types of counseling approaches to supervision may be beneficial for sustaining staff morale and team working, particularly important at a time when demands on genetic services are increasing. Effective models of counseling supervision will help to sustain the work of genetic counselors, which in turn will benefit patients and their families.

Association of family history with patient characteristics and prognosis in a large European gastroesophageal cancer cohort

INTRODUCTION

The role of the family history in the development and prognosis of gastroesophageal cancer is a controversially discussed topic as appropriate data from western cohorts are lacking. This study aims to explore its associations with disease and outcome parameters in a large European cohort.

METHODS

We retrospectively analyzed self-reported family history in patients with gastroesophageal cancer treated between 1 January 1990 and 31 December 2021 at the Medical University of Vienna. Association analyses with patient characteristics, tumor characteristics, symptoms and overall survival (OS) were performed.

RESULTS

In our cohort of 1762 gastroesophageal cancer patients, 592 (34%) reported a positive family history of cancer (159, 9%, gastroesophageal cancer). No associations were found with histopathological parameters or initial symptoms; however, a positive family history correlated with female gender (cancer in general: p = 0.011; gastroesophageal cancer: p = 0.015). Family history of cancer in general was associated with earlier cancer stages (p = 0.04), higher BMI (p = 0.005), and alcohol consumption (p = 0.010), while a positive history for gastroesophageal cancer was associated with higher age at diagnosis (p = 0.002) and stomach cancer (p = 0.002). There was no statistically significant association of positive family history with OS (p = 0.1, p = 0.45), also not in subgroups for histology (adeno and squamous cell), number of family members and degree of relative.

CONCLUSION

Our results emphasize that a positive family history is neither statistically significantly associated with prognosis nor with specific histopathological features in patients with gastroesophageal cancer. Yet, associations with distinct patient characteristics and positive family history indicate that specific subgroups might profit from endoscopic surveillance. Prospective studies are warranted to investigate these findings further.

Promoting reflective practice: Exploring access to supervision in European genetic counselling programmes

Genetic Counselling Supervision (GCS) plays an integral role in professional development, stimulating reflective practice and helping to prevent burnout. Nevertheless, evidence points to insufficient practice of GCS. This study aimed to explore the current state of counselling supervision access during MSc training, along with barriers and facilitators for its implementation. MSc coordinators of the current EBMG accredited programmes were invited to participate in this study via email, with the request to fill out a questionnaire. The qualitative data obtained was reviewed using thematic analysis, while descriptive statistics was used for the quantitative data. GCS was considered crucial for fostering professional development, safe practice, and emotional support for the future professionals. While all MSc programmes included counselling supervision in their course curricula, its implementation was highly heterogeneous. Students have access to GCS during clinical placements in 62,5% of the programmes, facilitated by institutional support and EBMG guidelines. Several barriers hindered its broader implementation, as was the case of a shortage of senior genetic counsellors and the lack of professional recognition in some countries. This study compiled evidence of the insufficient practice of GCS across Europe and its limited integration in MSc programmes. Therefore, we recommend educational pathways actively promote genetic counselling supervision routines to ensure graduates enter the workforce with the necessary tools to provide care with the expected standard of safety and quality, while maintaining a reflective practice.

Genomics as part of Portuguese undergraduate nursing programs: are we moving in the right direction?

The integration of genomics into nursing education has been a growing focus in recent years, as the role of genomics in healthcare continues to expand. Although the fundamental role of nurses in integrating genomic information into patient care is well-documented in the literature, studies have consistently highlighted significant gaps in nurses' understanding of these topics, impacting their ability to provide comprehensive care. This study aims to explore how genomic knowledge is taught in Portuguese undergraduate nursing education at a national level. A deductive content analysis was performed on explicit genomic content in each course specification within the nursing programs. A total of 478 course descriptions from 12 nursing programs were analyzed. Of these, only 25 courses (5.2%) explicitly referenced genomic content. Results reveal significant variability across programs, with some covering a considerable number of genetic topics, while others showed minimal or no coverage of genomic topics. Results also show that topics related to basic molecular biology and fundamental genetic principles tend to be more emphasized in nursing curricula compared to those focused on psychosocial aspects or patient-centered care. This inconsistency highlights the lack of a standardized approach to integrating genomics into nursing education. These findings suggest that the current approach to Portuguese nursing education is insufficient for preparing nurses to effectively address genomic issues in patient care and research. This research argues for a more systematic, early, and consistent integration of genomics across all nursing programs to ensure that future nurses are well-equipped to meet the challenges of modern healthcare, ultimately improving patient outcomes.

How can a community of practice support healthcare professionals navigating new roles? a case study of genetic counsellors employed to work in medical specialities

BACKGROUND

Communities of Practice (CoPs) have been implemented in healthcare settings to enhance knowledge translation and facilitate the implementation of new practices. However, their role in supporting healthcare professionals transitioning to new environments remains under-researched. This study examines a CoP designed for genetic health professionals in Australia who were employed to support the integration of genomics in medical specialities. Informed by the i-PARIHS framework, we explore how the facilitation of a CoP external to the implementation setting can support health professionals implementing innovative practices.

METHODS

Data was collected through qualitative interviews with 14 genetic counsellors participating in the CoP through different stages of their new roles, 35 discussion and reflection logs, and workshop and meeting notes. Thematic analyses were carried out to capture the patterns and process of facilitation performed by this CoP, resulting in five overarching themes.

RESULTS

Participants highlighted the unique role of the CoP in forging peer connection and providing emotional support in new environments with a high degree of uncertainty and limited peer support. Through CoP sessions and associated professional development workshops, they benefited from ongoing knowledge acquisition about good practices and innovations. The CoP served as an effective space for identifying and solving problems collectively or escalating emergent issues. Additionally, the CoP helped participants build inter-personal skills to overcome relational challenges and improved communication with non-genetic colleagues about genomics. Critical reflection emerged as both a practice and an impact of the CoP, enabling participants to redefine their roles and adopt future-oriented thinking for the genetic counselling profession.

CONCLUSION

The collaborative environment fostered by the CoP offered significant benefits to genetic professionals, facilitating their transition to new practice settings and supporting essential knowledge and skill development crucial for their success in introducing genomics in speciality patient care.

Supervision for genetic counselors: The role of career-long supervision to develop resilient practitioners

Supervision is a professional activity that provides practitioners with opportunities to reflect on, integrate and learn from work experiences, build resilience, and develop and review their professional identity through reflective conversations with a supervisor and/or peers. Supervision involves a contractual agreement between a supervisor and supervisee (practitioner), that recognizes the accountability of the supervision process to professional and organizational standards and protocols. Incorporating supervision into practice for genetic counselors at all career stages provides a way to develop and strengthen competence and practice and support genetic counselor well-being and client safety. Evidence also suggests that active engagement with effective professional supervision reduces the likelihood of burnout in healthcare workers. Genetic counselors in some parts of the world, including Australia, New Zealand, and the United Kingdom, participate in career-long supervision as a requirement of certification and registration. As the genetic counseling profession expands and diversifies, individuals and professional societies are encouraged to embed the practice of supervision beyond graduate training, establishing a professional culture that values career-long facilitated reflection and learning. We propose the establishment of a global genetic counseling supervision community of practice for genetic counselors interested in developing supervision practices and sharing resources.

The dilemma of X-linked agammaglobulinemia carriers

Background

Many patients with X-linked agammaglobulinemia (XLA) nowadays have reached adulthood, as well as their sisters, possibly carriers of a deleterious Bruton tyrosine kinase variant. Studies on motherhood outcomes in families with XLA are lacking.

Objective

We sought to investigate adherence to carrier status screening, interest in preconception and prenatal genetic counseling, and reproductive decisions in relatives with XLA.

Methods

In this multicenter, retrospective cohort study, we collected a 3-generation pedigree and data on mothers and sisters of patients with XLA, including carrier status and pregnancy outcome.

Results

Data on 53 adults with XLA, 52 mothers, and 33 sisters were collected. All XLA sisters received genetic counseling. Forty percent of the sisters chose to undergo carrier status determination, and 60% of them chose invasive prenatal testing. The main reasons for the sisters to decide not to undergo genetic testing were their young age and the willingness to carry on with the pregnancy regardless of the outcome of the genetic test, followed by the willingness to postpone the decision at the time of pregnancy and the decision to not have children. Prenatal testing resulted in 5 XLA diagnoses, with 2 pregnancy terminations, 1 miscarriage, and 2 XLA live births. Three carriers refused prenatal testing and had 6 live births, including 3 XLA-affected sons. One sister was diagnosed as a carrier after the birth of an XLA-affected son. In total, 9 XLA diagnoses were made, including 6 live births.

Conclusions

A number of XLA sister carriers decided to carry on with their pregnancy after receiving the diagnosis of an affected fetus or after refusing prenatal testing. We propose to initiate a more extensive collaborative study to verify the effect of genetic counseling on families with XLA in other cohorts from different countries.

Thirty-years of genetic counselling education in Europe: a growing professional area

Genetic counselling education and training in Europe spans a continuum of 30 years. More master programs are opening due the demand for qualified genetic counselors. This report describes the evolution of training in Europe and the current state of genetic counselling training programs. Directors of master programs in Europe were invited to complete an online survey describing their program, including year of commencement, course duration, number of students and frequency of intake and number graduating. Results of the survey were presented at a closed meeting at the European Society of Human Genetics conference in 2022 along with a facilitated stakeholder engagement session in which 19 professionals participated to understand the challenges in delivering genetic counselling education in Europe. A total of 10 active programs exists in Europe with the first training program starting in 1992. The majority of training programs have a 2-year duration, with just over half of programs having an annual intake of students. Up to May 2022, 710 students have graduated from genetic counseling training programs across Europe. Of these, 670 students graduated from European Board of Medical Genetics-registered programs. Arranging clinical placements, clinical and counseling supervision of students, research collaboration for MSc research projects and incorporating genomics into the curriculum were identified as current challenges for genetic counseling education. Genetic counseling is still a developing profession in Europe and this historical and current view of the European genetic counselor pathways, allows for educational and professional standards to be examined as the profession evolves into the future.